Initial mechanical ventilation settings

Revision as of 06:26, 24 August 2015 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Ventilation (Settings) to Ventilation settings)

Initial

  • FiO2 100% and ween down
  • Rate 8-12/min
    • consider 5-6 for asthma w/ permissive hypercapnea
  • Mode
    • A/C = defalt (most)
    • SIMV = with obstructive airway disease and an intact respiratory effort (e.g. some COPD, asthma)
    • PC = with intact respiratory effort and non-severe respiratory failure (prefered in chronic vent)
  • PEEP 0-5 mmH20
  • TV 5-8 cc/kg (eg. 500-600cc)
    • (adjust to plateau pressure <35 cmH20)
  • I/E 1:3
  • PS (pressure support) 5-8cm to overcome ET

Table

Disease TV^ RR I:E PEEP
Nl lung 8 10-12 1:2 4
Obstruct 6 5-8 1:4 4
ARDS 6 12-20 1:2 2-15
Hypovol 8 10-12 1:2 0-4

^cc/kg

^^FiO2 always = 1.0

See also Ventilation (Strategies)

Changes

O2

  • PaO2 (ween to SaO2 >90% & PaO2 >60)
  • FiO2 (ween to <0.5 if poss)
  • PEEP (see ARDS schedule; if >10, should have art line)
    • (rule of 7s: decrease 1 FiO2 = 7 pO2)

CO2

  • PCO2
    • TV
    • Rate
  • (VE-1 x pCO2-1 = VE-2 x pCO2-2)
    • VE = minute ventilation (RR x TV)

pH

to increase pH 0.01 --> decrease pCO2 by 1

MISC (normally already set)

  • Inspiratory flow rate = 60L/min (100L/min with asthma)
  • Sensitivity = 1-2 cmH2O

See Also

Source